A woman who spent nine years pulling out her eyelashes due to stress has undergone a transplant to have them replaced.

The nurse, known only as Joanne, had suffered with trichotillomania (TTM), a condition that causes a person to impulsively put their hair out, from the age of six until 15.

Despite having not pulled her eyelashes for eight years, she had permanently damaged the hair follicles, causing the hair growth to become sparse.

Before and after: Joanne had been suffering from trichotillomania, the condition which causes people to compulsively pull their hair out, for nine years. After overcoming it, she decided to have an eyelash transplant

Despite beating trichotillomania nearly a decade ago, Joanne's eyelashes never grew back. She said she was afraid to leave the house without makeup and false lashes before the surgery

She was so distressed by her appearance that she decided to take drastic measures and undergo a new type of surgery.

The £4,000 procedure was carried out by transplant hair surgeon Asim Shahmalak, based at the Crown Clinic in Manchester.

After injecting a local anaesthetic into the eyelids, Mr Shahmalak took hair from the back of Joanne’s head and implanted it into her eyelid.

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And because the implants are made out of her head hair, they have continued to grow as if they are attached to her scalp and needs regular trimming and curling.

Before the surgery Joanne's eyelashes were almost completely bald, with only a few lashes at the outer edges of her eyes.

She had tried to create the illusion of eyelashes by wearing heavy eyeliner and false eyelashes.

Joanne, from Manchester, said: 'From a young age I
suffered from trichotillomania which had a profound effect on my life
both physically and mentally.

'As I became older I was more aware of what others around would think and it consequently had a great effect on my confidence.'

Joanne was so pleased with the results of her first transplant, she underwent a second three months later to give her an ultra-lush set of lashes.

TOWIE star Sam Faiers, 21, has suffered with hair-pulling disorder TTM since the age of seven

'When I got to the age of 13 I began to cover up the noticeable gaps with eyeliner.

'However, I was still afraid that other people would find out, especially when it came to
school because make-up was just not allowed.

'By the age of 15, I had overcome
trichotillomania but I was still left with the effects of the years of
pulling out my eyelashes, as they just did not grow back.

'I remember thinking that if there was
some procedure that could replace the missing eyelashes then my life
would be changed forever,as I wouldn't wake up in the morning
and put make-up on to cover it up before even seeing other members of my
family.'

Joanne said the two successful transplants she had have ended ‘a 17 year nightmare.’

She said: 'Dr Shahmalak arranged for a beauty therapist to be present which was really useful as she was able to advise me how to care for my eyelashes and also what products to use to ensure they remain in great condition.

'Following my eyelash transplants, I am a much more confident person – saying this has transformed my life would be an under-estimation.

WHAT IS TRICHOTILLOMANIA (TTM)?

TTM is a condition that causes a person to feel compelled to pull their hair out and often eat it.It is usually carried out in secret.

The condition is thought to affect up to 248,000 British people. It tends to start in early teenagehood and is more common in girls.

It is not clear what causes TTM but experts have described it as a form of addiction, self-harm or a manifestation of severe anxiety.

Side-effects tend to be psychological - pulling hair and eating it brings on a sense of shame and can be disfiguring - but it can also cause balls of hair to build up in the digestive system.

Current treatment usually involves psychotherapy, antidepressant medication or hypnosis.

'I am now confident enough to walk around with no make-up on and even go shopping which, in the past, I would never have done.'

In total, the procedure took around four hours. Patients who undergo the procedure can go home the same day.

Eyelash transplants have been common in America for years but they only reached the UK four years ago.

Growing numbers of women are turning to eyelash transplants after damaging their natural lashes through repeated use of false eyelashes.

Some women also want fuller eyelashes
for cosmetic reasons. Celebrities like Cheryl Cole have made big
eyelashes very fashionable.

Others are seeking transplants due to trichotillomania.

Sam Faiers, 21, who stars on the TV show The Only Way Is Essex, has suffered from the condition since she was seven and has no eyelashes.

Dr Shahmalak has pioneered the treatment in the UK which is also often performed on burns and road traffic accident victims who have lost their eyelashes after being injured.

He said: 'There has been a big increase in referrals for two reasons.

'Firstly, because of brave women like Sam Faiers, more women are becoming aware of trichotillomania and seeking help.

'Secondly, the fashion for big eyelashes has meant that more women are wearing false eyelashes and damaging their natural lashes.

The glue used to fix false lashes can pull natural eyelashes out as the fake set is removed. If repeated frequently it can stop hair growing.

As with any hair follicle, eyelashes will cease to grow if they are repeatedly plucked out at the root.

'Hair transplant surgery may seem like a radical solution, but in many cases it is the only way of restoring eyelashes permanently.'